Our life span is largely decided by the genes we inherit from our parents, the development of various health problems, and accidental death. Our levels of education, income, and available health services also play a part. A healthy lifestyle including exercise, diet and preventive health care helps avoid or delay certain health conditions. Even so, as we age we are more likely to develop health conditions that will require treatment for the rest of our lives.
Accompanying these are the inevitable changes in our organs and body systems and how they work together. For the most part, aging changes are barely noticed because they occur so slowly. Since we have so much reserve capacity, they may not be noticed until function is very limited or a person becomes ill or injured.
Despite many health conditions and other effects of aging, most people in their late 80s and beyond enjoy lives of good quality and are fairly independent. However, their ability to be independent is at risk. An acute illness, a worsening of chronic illness, injury, surgery or a poor effect of medication or treatment may cause a hospital or nursing home admission.
'Frail' describes people who have difficulty carrying out the independent activities needed for day-to-day living because of aging, disease or disability. Seniors who are frail may manage well in their own home with family and home care support. Still, they may be less able to respond to challenges, and a minor illness may cause serious problems in their ability to function.
Usually, when a patient reports symptoms to the doctor, a history is taken during which questions narrow down the possibilities. During the exam, the doctor may find signs that confirm or prove wrong a possible diagnosis. Further tests may be required to verify a diagnosis. Physical and mental health conditions are usually diagnosed by typical patterns of signs and symptoms. For example, fever, tiredness, sharp chest pain and cough suggest pneumonia. A heavy pain in the central chest that moves down the inside of the left arm, along with great weakness, often signals a heart attack.
Although typical signs and symptoms of illness may develop, seniors, and their family and caregivers, should understand that an illness may not take the same form in an older adult. Many older people, particularly frail seniors, may have symptoms that can be mistaken for other health problems or as an effect of aging.
For example, a frail senior with pneumonia might have little or no fever, but become confused or have trouble with bladder control. A senior with a heart attack may have no pain but might fall down or have trouble managing household tasks. Someone experiencing side effects from medication may become weak, lose appetite and weight, and be needlessly tested for cancer. Delirium, a change in mental abilities, is common when a frail senior is sick or in hospital. It may occur alone or with other problems of aging.
A treatable illness may cause a decline in function. To find the problem, the doctor, often working with a health care team, carries out a Comprehensive Geriatric Assessment. This assessment takes a detailed look at a senior’s physical and mental state and ability to function.
'Polypharmacy' refers to taking many medications at the same time. Prescribed medications, over-the-counter drugs and complementary or alternative medicine used to treat illness can cause side effects. These may range from being slightly bothersome to life threatening. Prescribed drugs only become available after careful testing of how well and safely they work. Over-the-counter drugs are tested in the same way but are also judged to be safe enough for self-medication.
For the most part, alternative and complementary medicines have not had the same strict testing. Taken properly, most medications cause few problems. However, almost all substances used to prevent or treat illness may cause side effects in some people. Drugs may also react with each other. Studies show that when six or more drugs are taken at the same time, the risk of side effects rises greatly.
Taking many medications is not in itself a bad thing. Many illnesses common in old age can be treated well with medication. For example, an 85-year-old woman may be correctly prescribed a number of drugs for a variety of chronic health problems: High blood pressure (3 drugs), heart problems (2), lung disease (2 inhalers), Parkinson’s disease (2), osteoporosis (3, including vitamins and minerals), and glaucoma (2 eye drops), for a total of 14 medications. These medications will control illnesses and reduce the risk of future problems. Moreover, they help her maintain her independence and ability to manage her own medication use.
It is important that the drugs are appropriate. Finding the right medications involves a thorough assessment by the doctor and, when necessary, by other members of the health care team. The senior’s health goals, as well as avoiding drugs, doses and combinations of medications likely to cause side effects, must be considered.
Although many drugs may cause problems, some are more likely to cause problems for seniors. These include drugs for:
All of these can be valuable if used carefully and for the right reasons. However, side effects that affect memory, thinking, mobility and bladder control may occur when frail seniors use them.
Aging and diseases affect sleep patterns of older people. They may have more trouble getting to sleep, more frequent waking and more difficulty returning to sleep after waking. Many of the drugs for these conditions can greatly improve the quality of life for older people if used properly. However, certain drugs, particularly long acting benzodiazepines (such as Valium™) may be linked with confusion, trouble with balance and falling. These medications and others like them should generally be avoided. When necessary, most of these types of drugs are prescribed to seniors in lower doses than those used for younger adults. It is not a good idea to take sleeping medications over a long period of time.
High blood pressure (hypertension) is more common among older people. At one time, doctors and older people tended to ignore or under-treat blood pressure. Recent research now confirms the benefits of treating blood pressure well into old age. Newer medications for high blood pressure work better and have fewer side effects. However, these medications combined with fluid pills can cause too much of a drop in blood pressure, particularly when a person stands up. This is called postural hypotension, and can cause a person to fall.
Nonsteroidal anti-inflammatory drugs work very well to reduce pain and inflammation in arthritis and related conditions. However, they do interfere with the medications used for blood pressure or heart failure. These drugs, particularly the older ones, may cause severe stomach bleeding and kidney problems along with other side effects and should only be used for short periods of time. If used for a long time, their use and interference with other medication needs to be checked regularly.
Seniors benefit greatly from the diagnostic and treatment resources of modern medicine. However, frail seniors with many health problems are at risk for developing further health problems. Poor effects of drugs, diagnostic tests, treatment, surgery, and hospital care can all cause illness. Illness can also come from the anxiety of misunderstanding complex medical information. The risks and benefits to the frail senior must be considered whenever deciding to investigate or treat. Doctors, seniors, and their families and caregivers need to consider carefully these decisions. When problems or illness do occur, treatment goals must be reviewed and reconsidered.
It’s possible for frail seniors to maintain independence and a good quality of life. Working together with their families and caregivers, doctors and other health care providers, seniors may achieve these goals.